Dental Procedure May Reduce Risk of Premature Births

A non-surgical dental procedure may reduce the risk of preterm birth in pregnant women with periodontal disease.

Dental Procedure May Reduce Risk of Premature Births

Premature Baby

A non-surgical dental procedure may reduce the risk of preterm birth in pregnant women with periodontal disease (pregnancy periodontal disease), according to study findings. Nearly 12 percent of babies in this country are born preterm (before 37 completed weeks of pregnancy), which increases their risk of death and lasting disabilities, such as mental retardation, cerebral palsy, lung and gastrointestinal problems, and vision and hearing loss. The report was published in the Journal of Periodontology and is based on 366 pregnant women who had chronic periodontitis ( serious gum infections that destroys attachment fibers and supporting bone that hold teeth in the mouth) and found as much as an 84 percent reduction of premature births in women who were less than 35 weeks pregnant and who received scaling and root planing. Researchers also found that adjunctive metronidazole therapy (an antibiotic used to treat infections) did not improve pregnancy outcome. In fact, women who were given the antibiotic after scaling and root planing had more preterm births than patients receiving scaling and root planing and a placebo.  “What this tells us is that scaling and root planing may significantly reduce a mother’s chance of having a preterm birth,” said said Marjorie Jeffcoat, D.M.D, study author and former Rosen professor and chair at the University of Alabama at Birmingham school of dentistry.  “We found no evidence that the addition of an antibiotic to scaling and root planing was of benefit in this study. However, more research needs to be conducted to determine the reason for the decrease in efficacy.”

Scaling and root planing one of the common periodontal procedures that is performed by a periodontist, a dental practitioner who specializes in prevention, diagnosis and treatment of diseases of the supporting tissues and placement of dental implants. The tooth-root surfaces are cleaned to remove plaque and tartar from deep periodontal pockets and to smooth the root to remove bacterial toxins.

“In light of these findings, I recommend that all women who are thinking of becoming pregnant or who are pregnant receive a full periodontal exam and diagnosis,” said Jeffcoat. “Women who are already pregnant when periodontal disease is detected are ideally treated with scaling and root planing in the second trimester, which is a pragmatic protocol according to most Ob-Gyn specialists.”

Non surgical Scaling and Root Planing

Previous research reported that periodontal infection causes a faster-than-normal increase in the levels of prostaglandin and tumor necrosis factor molecules that induce labor, thus causing premature delivery before the fetus can grow to a normal birth weight. However, this is the first intervention study that offers advice on reducing the risk of premature births with scaling and root planing therapy alone.

This is important information for the public and the medical community. Every mother wants to reduce her risk of having an unhealthy baby. A simple periodontal examination can give her the comfort of knowing that her oral health will not contribute to increasing her risk of having a preterm baby.

Study Background

The blinded, controlled, randomized study compared three treatment groups: dental prophylaxis plus placebo, scaling and root planing plus placebo, and scaling and root planing plus metronidazole to determine if periodontitis treatment reduces the risk of spontaneous preterm birth in pregnant women.

Study participants were recruited from a large prospective study of 3,000 pregnant women who were between 21 and 25 weeks gestation and who had at least three sites (the area between teeth and gums) with clinical periodontal attachment loss greater than or equal to three millimeters. Patients were randomly assigned to one of the three treatment groups with stratification on the following factors: previous spontaneous birth at less than 35 weeks, body mass index less than 19.8, or bacterial vaginosis (vaginal bacterial infection). Participants were 85 percent African-American, 13.4 percent married and had a mean maternal age of 22 at delivery.

Pyogenic Granuloma (Pregnancy Tumor)

Gum Inflammation

Similarity of treatment groups was compared for selected demographic data and the extent of periodontal disease. There were no significant differences among groups in the proportion of subjects having the following risk factors; maternal cigarette smoking, history of preterm birth prior to 35 weeks gestation, body mass index, positive vaginal fetal fibronectin, or the presence of bacterial vaginosis.

Periodontal diseases are serious bacterial infections that destroy the attachment fibers and supporting bone that hold your teeth in your mouth. When the attachment fibers are destroyed, gums separate from the teeth, forming pockets that fill with plaque and even more infection. As the disease progresses, these pockets deepen even further, more gum tissue and bone are destroyed and the teeth eventually become loose. Approximately 15 percent of adults between 21 and 50 years old and 30 percent of adults over 50 have the disease, with higher percentages often found in a pregnant population.

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Athletic Mouthguards and Concussion Prevention

Do athletic mouthguards have a role in reducing the incidence and severity of cerebral concussion in sports?

Athletic Mouthguards and Concussion Prevention

Forces for Trauma

Do athletic mouthguards have a role in reducing the incidence and severity of cerebral concussion in sports?

This is a controversial question now being asked by the sporting world, especially for high-impact sports such as hockey and football. The apparent increase in concussion rates has led to claims by dentists and over-the-counter sports mouthguard suppliers regarding the use and effectiveness of athletic mouthguards in reducing concussions. Numerous minor hockey leagues have introduced mouthguard rules as a possible result of concussion, rather than dental concerns.Though anecdotal, there are three possible theories on the potential benefits of properly-fitting athletic mouthguards and the reduction of the incidence or severity of head concussions. It should be noted that these are theories, which in most cases are NOT PROVEN in the medical/dental literature.

1. Direct dissipation and/or absorption of force of an upward blow to the jaw.
2. Increased separation of the head of the condyle and glenoid fossa
3. Increased head stabilization by activating and strengthening neck muscles.

Dissipation of forces

Mouthguard materials by nature must have shock absorption qualities. They must be resilient and yet soft enough to absorb impact energy and reduce transmitted forces. The thickness of mouthguard material is directly related to energy absorption and inversely related to transmitted forces when impacted. However, wearer comfort is also an important factor in their use. Thicker mouthguards are often not user-friendly. Transmitted forces through different thicknesses of the most commonly-used mouthguard material (ethylene vinyl acetate – EVA – Shore Hardness of 80) were compared when impacted with identical forces capable of damaging the oro-facial complex. The results showed that the optimal thickness for EVA mouthguard material with a Shore Hardness of 80 is around 4 mm. on the occlusal surface. All teeth must be properly covered and the bite balanced accordingly. Increased thickness, while improving performance marginally, may result in less wearer comfort and acceptance.

Forces from mandibular impact are attenuated with a mouthguard, resulting in fewer injuries. A mouth protector reduces pressure changes and bone deformation within the skull in a cadaver model. There is a decrease of 50% in the amplitude of the intracranial pressure after a blow to the chin when wearing a mouthguard.

Mouthguard

Increased Condylar Separation

When a properly-fitted and balanced custom-made mouthguard is in place there is a forward/ downward movement of the jaw, thus opening the space between the glenoid fossa and the condylar head. This may reduce the opportunity for the condylar head to directly impact the glenoid fossa after an upward blow to the jaw, thus reducing the impact and acceleration forces to the entire temporal region. Again, while it might be advantageous to significantly open this space for protection, an excessive thickness of material on the biting surface might compromise both comfort and performance.

Increased head stabilization by activating and strengthening neck muscles

Dr. Karen Johnston, a prominent Canadian concussion researcher, noted that: “The force required to concuss a fixed head is almost twice that required to concuss a mobile head”.  Further, there is some correlation between the degree of rotation that the head goes through on impact and the severity of the concussion that might result.

By activating additional head and neck muscles at the time of impact this arc of rotation might be decreased, leading to less harmful movement of the brain inside the skull. Some researchers have begun to show that by being able to clench down harder on a mouthguard the activation of the head and neck muscles might serve to stabilize the head. Some have suggested further that this effect might be in place whether or not the athlete sees the impact coming.

Muscle Strength and Head Stabilization:

  • Mouthguards and clenching may promote increased neck muscle activity
  • Stabilization of the head may decrease rotational arc during trauma

Blunt Trauma

The Bottom Line

As Dr. Paul McCrory once stated about the connection between mouthguards and concussions “Absence of proof is not proof of absence”. We should always remember that the primary role of mouthguards is the protection of the teeth and orofacial structures, and mouthguards should be primarily designed to accomplish this goal – with adequate protection in the areas most likely to be traumatized (maxillary incisor teeth).

However, there are some basic design elements that can and should be included in any mouthguard that might enhance the potential concussion-prevention aspects of mouthguards. All mouthguards should have an adequate thickness and should cover as much of the occlusal surface as the athlete can tolerate. Mouthguards must have proper retention built into them to ensure that they stay in place at the moment of impact. Mouthguards should not be over trimmed in the posterior, which might actually force the condyles into the glenoid fossae. All mouthguards should be balanced occlusally to ensure an even distribution of force across the entire surface.

In my opinion, over the counter “boil and fit” mouthguards are not sufficient in protecting against blunt force trauma. My recommendation is to have a dental professional properly fit the athletic mouthguard using occlusal analysis and the proper materials to provide the athlete with the absolute best fitting mouthguard.

For more information contact

with West Tennessee Periodontics and Dental Implants

in Jackson, TN at www.wtnperio.com

If you enjoyed this article you may also like this: “Dental Trauma in Intercollegiate Athletics“.  Thanks for reading!

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Oral Cancer Survival Rates

Early detection and treatment of oral cancer is essential for increasing survival rates. The 5-year survival rate has not improved significantly in the past 30 years.

Oral Cancer Survival Rates

Squamous Cell Carninoma

Early detection and treatment of oral cancer is essential for increasing survival rates. The 5-year survival rate has not improved significantly in the past 30 years. For all stages combined, about 82% of persons with oral cavity and pharynx cancer survive 1 year after diagnosis. The 5-year and 10-year relative survival rates are 59% and 48%, respectively. In whites, the survival rate is approximately 55%, while in blacks, it is only 31%. Oral cancer is the sixth most common cancer worldwide. In the US, it accounts for an estimated 35,000 cases of cancer and about 7,600 deaths annually. Oral cavity cancer constitutes about 17,000 of these cases per year and is more common than cervical or ovarian cancer, Hodgkin’s lymphoma, or leukemia.The average age at diagnosis is 63 years. Approximately 96% of oral cancers are detected above the age of 40, and more than 50% of all cancers occur in persons older than 65. However, recent evidence indicates oral cancers are becoming more prevalent in people younger than 40 years.The lifetime ratio of males to females receiving an oral cancer diagnosis is 2:1, although advancing age changes that ratio to nearly 1:1. However, oral cancers are twice as common in males compared to females.  The overall incidence of oral cancers has stabilized, relative to the occurrence of newly diagnosed cancers of all oral sites, with absolute numbers increasing only slightly each year.  More than 90% of these oral-pharyngeal cancers are squamous cell carcinomas (SCC). The remainder includes salivary gland tumors, lymphoma, and sarcoma.

Often, these malignancies begin as preneoplastic inflammatory lesions, such as leukoplakia, erythroplasia, and erythroleukoplakia. Leukoplakia is a common oral lesion, appearing as a highly phenotypically variable white patch, and may be associated with tobacco and alcohol use, as well as chronic inflammation. When these and other risk factors are present, the risk of malignant transformation to SCC may approach 17%.These leukoplakia (or other premalignant lesions) may become cancerous, especially if they demonstrate epithelial dysplasia. If epithelial dysplasia is diagnosed, the rate of cancer transformation may become as high as 42%. Alterations in host immunity, inflammation, angiogenesis, and metabolism have been noted as prominent clinical features in oral cancers.

Anatomic Sites
The most common site for oral cancers in both American men and women is the tongue, particularly the side surfaces. Recent data indicate about 37% (7,320:20,010) of all oral cancers, excluding the pharynx, occur on the tongue. However, populations in other parts of the world experience oral cancers differently: in India, buccal mucosa carcinomas are more common, and in Southeast Asia, nasopharyngeal cancer occurs more frequently. Data from the Surveillance, Epidemiology and End Results (SEER) Program demonstrate that 30% of all oral cancers diagnosed in the US between 1985 and 1996 occurred on the tongue, followed by the lip and floor of the mouth. Oral tongue cancers (in the anterior two-thirds) accounted for 53% of tongue cancers. The other oral anatomic sites are the lip (22%), floor of the mouth (13%), salivary glands (12%), buccal mucosa (6%), gingiva (6%), and palate (4%).

Tongue

Floor of the mouth

Soft Palate

Stage at Diagnosis and Survival
Unfortunately, the overall survival rates for oral and pharyngeal cancer have not improved significantly in the past 30 years. Furthermore, only 60% of these patients will survive 5 years following treatment.  These statistics are worse for tongue carcinoma: about 33%. In the US, the outcomes are more favorable for whites than blacks (55% vs 31%, 5-year survival rates). Undoubtedly, genetics are significantly involved in the predisposition to cancer; however, socioeconomic status, education, and access to the healthcare system also have an influence. The survival rates for advanced tumors are much lower compared with earlier-detected, localized cancers. At diagnosis, almost 50% of all carcinomas of the tongue have metastasized already. An additional 35% to 40% will do so within 5 years. If all oral cancers were diagnosed and treated early as localized tumors, almost 80% of these patients would have 5-year survival rates. This is a major reason for the importance of early detection and/or prevention of the premalignant lesion from progressing to carcinoma. Unfortunately, very little progress has been made in the past 40 years regarding early diagnosis. Additionally, based on more than 25,000 SEER Program oral/pharyngeal cases for which adequate information was available, advanced tumors outnumbered localized, early oral cancers by 59% to 41%. The lip was the only major site where localized cancers were found more frequently than more advanced cancers. Advances in the treatment of oral cancer have not led to significantly improved survival; therefore, earlier diagnosis is the most important factor in improving oral cancer control and reducing morbidity and mortality.

Etiology and Risk Factors
The etiology of oral cancers appears multifactoral, involving long-term exposure to carcinogenic substances, as well as alterations in host immunity and metabolism, angiogenesis, exposure to chronic inflammation, and possibly other factors that accumulate gradually in a genetically susceptible individual. The carcinogenic changes may be influenced by oncogenes, carcinogens, and mutations caused by chemicals, viruses, irradiation, cigarette smoking, excessive alcohol intake, hormones, diet, and physical irritants.

Tobacco
Reports from the US Surgeon General and others conclude that cigarette smoking is the main cause of cancer mortality in the US, contributing to an estimated 30% of all cancer-related deaths and substantially to head and neck cancers.

Tobacco and Alcohol

The association between cigarette use and oral carcinoma has been firmly established from epidemiologic studies, revealing there are more than twice as many smokers among patients with oral cancers as in control populations. One study found that 72% of more than 400 patients with oral cancers smoked, with 58% using more than one pack daily, demonstrating the high risk for tobacco users.

Tobacco use also increases the already high risk for recurrences of oral cancers as well as second primary oral and pharyngeal cancers. The combined effects of tobacco and alcohol are illustrated in another study of more than 350 patients who had oral cancers and a mortality rate of 31% within 5 years.

Alcohol intake also has been associated with the incidence of oral cancers, especially long-term excessive use. One group of investigators found that 44% of 108 patients with cancer of the tongue and 59% of 68 patients with cancer of the floor of the mouth, palate, or tonsillar fossa had unequivocal evidence of alcoholic cirrhosis. Approximately 75% drank alcohol excessively.

Definitive associations between alcohol-containing mouth rinses and the development of oral cancers have not been established.

Nutrition
Although some studies indicate a potential association with dietary factors and cancer in general, no clear characteristics, such as deficiencies or excesses of nutrients, have been recognized as directly correlating with cancers of the oral cavity.

Viruses
While the role of viruses in development of oral cancers is not known to cause oral SCC, other head and neck cancers have a defined relationship with viruses. Of the viruses that infect oral tissues, those having oncogenic potential are from two groups: the herpes viruses and papillomaviruses. The human papilloma viruses, especially type 16, are among the most likely candidates to cause oral cancers—at least in part. These viruses seem to be more related to pharyngeal cancer than oral cavity sites.

Clinical Examination
A comprehensive oral examination of every patient is essential to dental practice and for the early detection of oral cancers or premalignant lesions. The standard-of-care examination includes not only a thorough inspection of every intraoral mucosal surface but also the extraoral head and neck tissues, including lymph nodes. Any mucosal abnormality requires an action plan whether that includes treatment, biopsy, referral, or recall examination, and depends upon the nature of the lesion. Many oral lesions that are ill-defined, varying in appearance, controversial, and poorly understood may be benign but may present changes that could be confused easily with malignancy. Conversely, early malignancy may be mistaken often for a benign lesion. Some lesions are considered premalignant because of their statistical correlation with subsequent associated cancerous changes. It is understandable that a considerable amount of clinical uncertainty is involved in the early detection of malignancy, as well as in the understanding that many of these lesions may not remain benign.

Oral cancers may present clinically with different colors and morphologies. They may appear as leukoplakia (white), erythroplasia (red), and most commonly erythroleukoplakia (red and white). They can also be seen as plaques, macules, ulcers, exophytic papules, nodules or tumors, or granular and/or verrucous lesions. Often, SCCs present with very pleomorphic characteristics—combining several of these features—and may be fissured, indurated, and bleeding.

Signs and Symptoms
During the earliest stages, oral cancers are usually completely asymptomatic or may present with only mild irritation. Pain usually occurs in the later stages when the lesion advances and ulcerates. Therefore, thorough oral examinations are imperative for detection of the earlier asymptomatic lesions. Although the gold standard for diagnosis is a biopsy and histopathologic examination, visual morphologic changes may aid the decision to biopsy. Ulceration indicates that the lesion has penetrated through the lamina propria into the connective tissue. Rarely, a patient may seek initial consultation because of a swelling in the neck, which represents a metastasis from an oral lesion of which the patient may be completely unaware. Although there are always exceptions, the following are common presenting signs of oral carcinoma:

Erythema: Redness of the mucosa that reflects inflammation, thinness, and irregularity of epithelium, as well as a lack of keratinization.

Erythema

Ulceration or erosion: Occurs with the destruction of epithelial integrity, owing to discrepancy in cell maturation and disruption of basal lamina (basement membrane).

Ulcerations

Fissuring: The surface texture of the lesion may exhibit ridges and irregularities that reflect abnormal cell growth.

Fissuring

•  Leukoplakia: A white patch on the mucosal surface, reflecting excess epithelial keratin production. Hyperkeratosis is associated often with well-differentiated carcinomatous lesions. Excess keratin also may be produced within the stratified squamous epithelium and can appear as “keratin pearls.”

Leukoplakia

Erythroplakia: A red macule, plaque, or exophytic lesion that may look similar to trauma or inflammation but may, in fact, represent early angiogenic activity and premaliganancy. The most common clinical presentation of oral precancerous lesions includes some erythema.

Erythroplakia

Diagnosis and Management
Patients with leukoplakia or other premalignant lesions and even early SCCs are usually asymptomatic. The lesion is usually discovered by a clinician during a routine examination or by a patient who feels roughness in the mouth. No reliable clinical signs and symptoms associated with oral leukoplakia relate to an accurate prediction of a premalignant or early malignant change. However, even mild symptoms are often suggestive of a dysplastic epithelial alteration or an early invasive tumor. Because the clinical appearance of oral leukoplakia—thick or scant, large or small—does not reliably indicate its biologic potential, clinicians should be suspicious of all white lesions and carefully evaluate and observe these patients. The diagnosis of these lesions must be made by histopathologic evaluation.

Adjunctive Clinical Diagnostic Aids

While not intended to be diagnostic tests, adjunctive clinical diagnostic aids may benefit clinicians and patients alike when choosing between a scalpel or punch biopsy. These aids may enhance oral mucosal examinations and perhaps facilitate the procurement of a biopsy, which is the gold standard for diagnosing oral pathology.

In a recent comprehensive review in the Journal of the American Dental Association, Patton et al concluded uncertainty persists as to whether adjunctive screening techniques actually improve the numbers of oral cancers diagnosed or the mortality and morbidity associated with them.Evidence is insufficient for either supporting or refuting visually based screening adjuncts in dental practice. However, their review concluded there is data supporting the benefits of toluidine blue vital staining.

  • Chemiluminescence and Toluidine Blue

    Toluidine Blue

  • Direct Optical Fluorescence

    Optical Fluorescence

  • Transepithelial Cytologyand Brush Biopsy

    Brush Biopsy

Treatment

Long-term survival and functional results of treatment depend on the tumor stage, histology, and treatment plan.The treatment plan is developed at pretreatment conferences (tumor boards) by multidisciplinary consultants and subsequent patient and family concurrence. Additional important outcome factors include the patient’s nutritional status, general health, tobacco use, alcohol intake, and likelihood of compliance with the rigors of therapy.

Curative treatment modalities can be local surgery with wide margins, radiation, or a combination of both. Chemotherapy may be used with these modalities to enhance cure rates and preserve function, which has led increasingly to organ preservation strategies. If survival of the patient is in question, the choice may be to just employ palliative measures to ensure pain control and quality of life.

Otolaryngologists, radiation oncologists, dentists, and rehabilitation specialists work cooperatively in the treatment process. The side effects of treatment are permanent and diminish oral function. Treatment planning is based on careful cancer staging and selection of therapies, which allows for prognostication and facilitates the reporting of outcomes. Physical examination, open biopsy, or fine-needle aspiration biopsy, as well as radiologic imaging studies that include computed tomography, magnetic resonance imaging, and positron emission tomography, are used to classify and stage.

Most major functional disabilities following treatment are related to the disease volume, the degree of radiation, and/or chemotherapy required for treatment that relates to the postoperative complications, including the extent of mandible or tissue loss, reduction of tongue mobility, caries and loss of dentition, xerostomia, muscle trismus, diminished taste and mastication, risk of osteoradionecrosis, and anesthesia of the oral cavity. To achieve a cure, the treatment plan considers an adequate resection of the tumor and surrounding normal tissue and the addition of the lymphatic drainage, while attempting to preserve as much normal anatomy and physiology as possible.

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Making a Dental Practice Eco-Friendly

X-rays to amalgam fillings, and from disinfecting chemicals to water usage, the products associated with the dental industry have an impact on the environment.

Making a Dental Practice Eco-Friendly

FromGo Green traditional x-rays to amalgam dental fillings, and from disinfecting chemicals to water usage, the products and practices associated with the dental industry have an impact on the environment. According to the Eco-Dentistry Association, traditional x-rays generate 4.8 million lead foils that must be disposed of every year, and 28 million liters of toxic x-ray fixer. Additionally, one of dentistry’s biggest areas of waste and landfill impact is the use of disposable infection-control and sterilization methods.“The statistic we have is that every year, US dental practices dispose of 1.7 billion sterilization pouches and 680 million chair barriers, light handle covers, and disposable patient bibs,” says Ina Pockrass, JD, co-founder of the Eco-Dentistry Association and Transcendentist, Inc, the nation’s first green dental practice. “All of that waste could be eliminated by using reusable cloth methods combined with an appropriate and environmentally friendly cleaning products.”

If every dental office in the United States were to incorporate dental digital imaging and go “green,” rather than using traditional x-rays, those 4.8 million lead foils and 28 million liters of x-ray fixer would be eliminated. Additionally, there are a number of surface disinfectants available that are effective which eliminate the need to put plastic bags over the dental chair.

Digital X-Rays

Further, the EDA estimates that the US dental industry disposes of at least 3.7 tons of mercury-containing waste every year. This is caused solely by the fact that far less than the majority of dental offices currently have an amalgam separator.

In the past year alone, it is estimated that more than 18,000 containers, weighing on average 7 lbs each were sent to a special recycling facility, which equates to taking roughly 63 tons of mercury-laden waste not entering the environment. The Environmental Protection Agency (EPA) is currently reviewing options related to regulating the dental industry for mercury discharge and requiring Best Management Practices to include the installation of amalgam separators. Currently a voluntary program with the support of the American Dental Association (ADA) is underway with limited success, he says.

What Are Practices Doing to Go Green

In recent years, Aspen Dental has undertaken taken several initiatives to help the organization “go green,” ranging from eco friendly building materials to investing in more eco-friendly technologies, explains Robert Fontana, president and CEO for Aspen Dental Management, Inc. The company’s Practice Support Center in East Syracuse, New York, which opened in August 2006, was built with sound environmental practices and to meet Leadership in Energy and Environmental Design (LEED) certification requirements, he says. In fact, its features include high-efficiency, low-energy lighting using T-4 light bulbs; special roof membrane (ie, white, rather than black, membrane that helps reflect heat and sun to reduce cooling costs); high efficiency heat pump that provide cooling in summer and heating in winter; tinted, low-E windows; low-VOC paint; and furniture and carpeting that meets LEED certification standards.

“We’ve taken a similar approach in our more than 220 dental offices in 19 states. The offices feature low-wattage overhead lighting; a dry vacuum pumps for suction equipment rather than traditional wet-ring vacuum systems that use as much as 800 gallons of water a day; and oil-less air compressors used to operate dental instruments,” Fontana says. “Our offices are using digital radiography, which eliminates the use of any developing fluids which are harmful to the environment, as well as the by-products generated by film processing. In those few offices where we have not yet transitioned to dental digital radiography and still have conventional x-ray machines that use film, we recycle the chemistry to prevent the chemical and residual heavy metals from entering the waste stream.Most offices have amalgam separators, and in addition, we have moved from the use of neon in our facility channel signage to more energy-efficient LED lighting.”

Additionally, Fontana explains that at the office administration level, Aspen Dental is moving toward electronic dental records, which not only will help the company significantly cut down paper use, but also represents a more efficient way to manage patient care. In its laboratories, the company is looking to consume less material and streamline its processes to produce less waste.

One simple thing dental offices can do include setting their copiers to double-sided paper, which will reduce by half the amount of copy paper used. Additionally, somebody in the office—perhaps whoever is the last person out at night—can be assigned to ensure that all of the computers and all of the equipment is actually turned off, she adds.

Dentists are wasting hundreds of dollars a year in energy costs simply by not turning off equipment that is taking a phantom load all night long while it is not actually in use.

Another easy thing dentists can do is switch to cloth sterilization methods, which have been used in the hospital setting for hundreds of years. I personally use Enviropak pouches instead of throw away pouches.

Reusable Enviropouches

“It just makes economic sense,” Pockrass asserts. “It’s much cheaper than buying and storing plastic and paper pouches.”

For practices that want to do more to become environmentally responsible, the EDA established the GreenDOC program (ie, Green Dental Office Certification). The GreenDOC program is designed specifically to enable dental professionals to achieve the highest standards currently demanded for becoming a green dental office. In particular, the GreenDOC “How-to-Guide” provides precise ways of setting up a benchmark in order to obtain certification. Worksheets and action plans provide an accurate way to document a practice’s application for certification for becoming a green dental practice.

How Dental Manufacturers Are Getting Involved

According to Eric Shirley, vice president and general manager of Midmark Corporation, his company has been designing several green and eco-friendly products for years, the best example of which is its casework. This dental cabinetry is CARB (California Air Resource Board)-compliant, and it also is compliant with some of the LEED initiatives.

Other examples of eco-friendly and “green” products from Midmark include digital x-ray products that require no chemical or paper to produce radiographic images, and a dry vacuum system that provides suction for the entire office without using any water. According to Shirley, this vacuum requires no oil maintenance, since it is sealed inside the machine itself.  “This really cuts down on an office’s water usage,” Shirley says. “For our traditional water vacuums, we do offer a water recycler that will recapture about 87% of the water that’s utilized.”  According to Pockrass, the average dental office that uses a water vacuum system wastes 360 gallons of water every day. Overall, the US dental industry is responsible for pouring down the drain about nine billion gallons of water every year, she adds. However, converting to a waterless vacuum system would save that water.  “We’re really excited to see that the dental industry has begun to introduce innovations in product areas such as compostable suction tips and LED operatory lights that are more energy efficient and give dentists a very true color match,” Pockrass says. “An eco-friendly gauze was recently introduced, so there are opportunities abounding now for dental professionals to have the products readily available to them to create an authentically green practice.”

Shirley notes that producing eco-friendly products sometimes means turning away from the cheaper materials. For example, for the company’s cabinetry, they chose to use sustainable materials, even though it could source much less expensive materials.

“We believe that the materials that we choose are not only sustainable, but that they also are very durable,” Shirley has observed. “It’s not necessarily more profitable to produce eco green products. We do it because we think our customers respond very well to those types of products. We also think that in some cases, they lend a little bit more durability to the product itself.”

Benefits of Green Dentistry

“The biggest benefit of green dentistry is reducing adverse impacts on the environment,” says Chris Miller, PhD, associate dean emeritus at the Indiana University School of Dentistry. “It is not likely (but possible) that a green infection control product will actually enhance infection control, but if it is kinder to the environment and does not compromise infection control, then it is worth considering.”

Miller says that he’s not aware of any published studies regarding the effects of going green on dental infection control. He comments that going green in terms of infection control likely would not enhance disease prevention. However, he cautions that compromising some infection control procedure to go green could increase chances for disease spread.

But going green does offer other types of benefits to dentists and patients alike.

Dry Vacuum Pumps

“Take the digital radiography system that our offices use,” Fontana suggests. “It’s quicker than a traditional x-ray and takes clearer images, which makes practicing dentistry more efficient for our clinicians and translates into greater comfort for our patients. The benefits of digital radiography are even more impressive when you consider the sheer scale of our footprint.”  Fontana cites the organization’s new online payment system as another eco-friendly benefit. This has helped not only cut down paper usage for billing purposes, but also gives patients a convenient way to manage their account and make payments, he says.

Shirley says that when dental practices incorporate specific eco-friendly products that require almost zero maintenance and/or are made from sustainable, durable materials, dentists benefit from a combination of cost savings, value, and positive patient perception. The patient understands that what they are seeing in the operatory is a more durable product, one designed to be sustainable, and many patients today are responding favorably to that, he says.

Making the Choice to Go Green

When dentists are ready to make more green choices, they need to remember that green practices reuse, rather than dispose. Therefore, green choices would include using autoclavable metal suction tips, rather than disposable plastic suction tips. Although plastic suction tips are recyclable, they’re not reusable. Metal suction tips are convenient and can be sterilized, reused, and save money. Additionally, steam sterilization methods can produce time-efficient and reliable results. Steam sterilization easily penetrates tools wrapped in surgical, lint-free materials. This approach is eco-friendly because no external ventilation is required for chemical vapors, and the need for disposing of hazardous wastes like toxic chemicals into the water supply also is eliminated.  Because green dental practices may implement cloth barriers, the practice also may choose to incorporate energy-efficient washers and dryers. When it’s time to remodel or redecorate, eco-friendly choices can include the installation of low-flow faucets and toilets in order to ensure proper water use and waste water management, as well as the use of floor varnish and paints that contain no volatile organic compounds (VOC) that will decrease the amount of toxins is the air.

We all need to do our part to protect the environment for future generations.  However, we must first have a clear, evidence-based understanding of what that means so as not to jeopardize the safety of those currently engaged in the healthcare system, including patients and the dental team.

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2 Responses to “Making a Dental Practice Eco-Friendly”

  1. Very informative! As in all such endeavors, every little bit helps.

  2. I just like the valuable info you provide for your articles. I will bookmark your weblog and check once more here regularly. I am slightly certain I will be told plenty of new stuff right here! Good luck for the next!

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Oral Bacteria Found in Amniotic Fluid

Any disruptions in the amniotic fluid, such as a bacterial infection, could potentially be dangerous to both the mother and baby.

Oral Bacteria Found in Amniotic Fluid

Pregnancy

A study appearing in the Journal of Periodontology identified bacteria commonly found in the mouth and associated with periodontal diseases in the amniotic fluid of some pregnant women.

The study, which evaluated 26 pregnant women with a diagnosis of threatened premature labor, found the presence of periodontal bacteria, P. Gingivalis, in both the oral cavity and amniotic fluid in 30% of the women. Amniotic fluid is a liquid that surrounds an unborn baby during pregnancy. Any disruptions in the amniotic fluid, such as a bacterial infection, could potentially be dangerous to both the mother and baby.

“We evaluated women who were at risk of premature labor,” said study author Gorge Gamonal, Faculty of Dentistry, University of Chile. “We know that there are many reasons a woman can be diagnosed with threatened premature labor, including bacterial infection. Past research has shown a relationship between adverse pregnancy outcomes and periodontal disease, a chronic bacterial infection.”

“While this study’s findings do not show a direct causal relationship between periodontal diseases and adverse pregnancy outcomes, it is still important for women to pay special attention to their oral health during pregnancy,” explained Preston D. Miller, DDS and AAP president. “Woman who are pregnant or considering becoming pregnant should speak with their dental and health care professionals about their oral health during pregnancy.”

Bacteria

Although this information does not directly link periodontal (gum) infection to problems relating to pregnancy, the fact that periodontal pathogens were found in amniotic fluid is an interesting finding that should not be ignored. It is of the utmost importance to maintain good oral hygiene and regularly see  a dental professional during pregnancy to make sure that you are not experiences any periodontal problems.

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What Are Dental Implants

Tooth implants are an ideal option for people in good general oral health who have lost a tooth or teeth due to periodontal disease, an injury, or some other reason.

What Are Dental Implants

A dental implant is a prosthetic (artificial) tooth root that a periodontist places into your jaw to hold a replacement tooth or bridge. Tooth implants are an ideal option for people in good general oral health who have lost a tooth or teeth due to periodontal disease, an injury, or some other reason.

While high-tech in nature, dental implants are actually more tooth-saving than traditional bridgework, since implants do not rely on neighboring teeth for support.

Dental implants are so natural-looking and feeling, you may forget you ever lost a tooth. You know that your confidence about your teeth affects how you feel about yourself, both personally and professionally. Perhaps you hide your smile because of spaces from missing teeth. Maybe your dentures don’t feel secure. Perhaps you have difficulty chewing. If you are missing one or more teeth and would like to smile, speak and eat again with comfort and confidence, there is good news! Dental implants are teeth that can look and feel just like your own! Under proper conditions, such as placement by a periodontist and diligent patient maintenance, implants can last a lifetime. Long-term studies continue to show improving success rates for implants.

What Dental Implants Can Do

  • Replace one or more teeth without affecting bordering teeth.
  • Support a bridge and eliminate the need for a removable partial denture.
  • Provide support for a denture, making it more secure and comfortable.

Types of Implants in Use Today

  • Endosteal dental implants(in the bone): This is the most commonly used type of implant. The various types include screws, cylinders or blades surgically placed into the jawbone. Each implant holds one or more prosthetic teeth. This type of implant is generally used as an alternative for patients with bridges or removable dentures.
  • Subperiosteal (on the bone): These are placed on top of the jaw with the metal framework’s posts protruding through the gum to hold the prosthesis. These types of implants are used for patients who are unable to wear conventional dentures and who have minimal bone height.

Endosseous Dental Implant

Advantages of Dental Implants Over Dentures or a Bridge

Every way you look at it, dental implants are a better solution to the problem of missing teeth.

  • Esthetic: Dental implants look and feel like your own teeth! Since dental implants integrate into the structure of your bone, they prevent the bone loss and gum recession that often accompany bridgework and dentures. No one will ever know that you have a replacement tooth.
  • Tooth-saving: Dental implants don’t sacrifice the quality of your adjacent teeth like a dental bridge does because neighboring teeth are not altered to support the implant. More of your own teeth are left untouched, a significant long-term benefit to your oral health!
  • Confidence: Dental implants will allow you to once again speak and eat with comfort and confidence! They are secure and offer freedom from the irksome clicks and wobbles of dentures. They’ll allow you to say goodbye to worries about misplaced dentures and messy pastes and glues.
  • Reliable: The success rate of dental implants is highly predictable. They are considered an excellent option for tooth replacement.

Are You a Candidate for Dental Implants

The ideal candidate for dental implants is in good general and oral health. Adequate bone in your jaw is needed to support the implant, and the best candidates have healthy gum tissues that are free of periodontal disease.

Dental implants are intimately connected with the gum tissues and underlying bone in the mouth. Since periodontists are the dental experts who specialize in precisely these areas, they are ideal members of your dental implant team. Not only do periodontists have experience working with other dental professionals, they also have the special knowledge, training and facilities that you need to have teeth that look and feel just like your own. Your dentist and periodontist will work together to make your dreams come true.

Implant/Bone Interface

What Is Treatment Like

This procedure is a team effort between you, your dentist and your periodontist. Your periodontist and dentist will consult with you to determine where and how your implant should be placed. Depending on your specific condition and the type of implant chosen, your periodontist will create a treatment plan tailored to meet your needs.

  • If you are missing a single tooth, a single tooth implant and a crown can replace it. A dental implant replaces both the lost natural tooth and its root.
  • If you are missing several teeth, implant-supported bridges can replace them. Dental implants will replace both your lost natural teeth and some of the roots.
  • If you are missing all of your teeth, an implant-supported full bridge or full denture can replace them. Dental implants will replace both your lost natural teeth and some of the roots.
  • A key to implant success is the quantity and quality of the bone where the implant is to be placed. The upper back jaw has traditionally been one of the most difficult areas to successfully place dental implants due to insufficient bone quantity and quality and the close proximity to the sinus. Sinus augmentation can help correct this problem by raising the sinus floor and developing bone for the placement of dental implants.
  • Deformities in the upper or lower jaw can leave you with inadequate bone in which to place dental implants. To correct the problem, the gum is lifted away from the ridge to expose the bony defect. The defect is then filled with bone or bone substitute to build up the ridge. Ridge modification has been shown to greatly improve appearance and increase your chances for successful implants that can last for years to come.

What Can I Expect After Treatment

As you know, your own teeth require conscientious at-home oral care and regular dental visits. Dental implants are like your own teeth and will require the same care. In order to keep your implant clean and plaque-free, brushing and flossing still apply!

After treatment, your periodontist will work closely with you and your dentist to develop the best care plan for you. Periodic follow-up visits will be scheduled to monitor your implant, teeth and gums to make sure they are healthy.

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Oral Cancer Mortality Rates

Oral cancer strikes an estimated 34,360 Americans each year. An estimated 7,550 people (5,180 men and 2,370 women) will die of these cancers in 2010.

Oral Cancer Mortality Rates

Oral Cancer Foundation

Approximately 35,000 new cases of oral cancer are diagnosed each year in the United States. Some 25 percent of those people will die of the disease.  According to the American Cancer Society, oral cancer occurs almost as frequently as leukemia and claims more lives than melanoma or cervical cancer.  Oral cancer incidence is rising among women, young people and non-smokers.Routine, careful examination of patients is appropriate and necessary. This can easily be achieved during a regular dental visit. The stage at which an oral cancer is diagnosed is critical to the course of the disease. When detected at its earliest stage, oral cancer is more easily treated and cured. When detected late, the overall five-year survival rate is about 50 percent.

Facts About Oral Cancer

Incidence and Mortality

  • Oral cancer strikes an estimated 34,360 Americans each year.  An estimated 7,550 people (5,180 men and 2,370 women) will die of these cancers in 2010.
  • More than 25% of the 30,000 Americans who get oral cancer will die of the disease.
  • On average, only half of those diagnosed with the disease will survive more than five years.
  • African-Americans are especially vulnerable; the incidence rate is 1/3 higher than whites and the mortality rate is almost twice as high.

Oral Cancer Screenings

Risk Factors

  • Although the use of tobacco and alcohol are risk factors in developing signs of oral cancer, approximately 25% of oral cancer patients have no known risk factors.
  • There has been a nearly five-fold increase in incidence in oral cancer patients under age 40, many with no known risk factors.
  • The incidence of oral cancer in women has increased significantly, largely due to an increase in women smoking. In 1950 the male to female ratio was 6:1; by 2002, it was 2:1.

No Smoking

Prevention and Detection

  • The best way to prevent oral cancer is to avoid tobacco and alcohol use.
  • Regular dental check-ups, including an examination of the entire mouth, are essential in the early detection of cancer and pre-cancerous conditions.
  • Many types of abnormal cells can develop in the oral cavity in the form of red or white spots.  Some are harmless and benign, some are cancerous and others are pre-cancerous, meaning they can develop into cancer if not detected early and removed. (American Cancer Society)
  • Finding and removing epithelial dysplasias before they become cancer can be one of the most effective methods for reducing the incidence of cancer.
  • Knowing the risk factors and seeing your dentist for oral cancer screening can help prevent this deadly disease. Routine use of the Pap smear since 1955, for example, dramatically reduced the incidence and mortality rates for cervical cancer in the United States.
  • Oral cancer is often preceded by the presence of clinically identifiable premalignant changes. These lesions may present as either white or red patches or spots. Identifying white and red spots that show dysplasia and removing them before they become cancer is an effective method for reducing the incidence and mortality of cancer.

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Iced Out Gold Teeth Grillz

Tooth grillz generally are removable but some wearers have had their teeth altered with gold dental crowns to permanently resemble a grill.

Iced Out Gold Teeth Grillz

Some celebrities have been flashing more than clean, white teeth at their fans. Under the spotlight, the glint from their mouths comes from “dental grills” or “gold teeth grillz”—decorative covers often made of gold, silver or jewel-encrusted precious metals that snap over one or more of their teeth.Teeth grillz, sometimes called “teeth fronts,” generally are removable but some wearers have had their teeth altered with gold dental crowns to permanently resemble a grill. And some have tried to attach their grill with permanent cement—something that is not meant for internal use and can damage the teeth and tissues!

At present there are no studies that show that grills are harmful to the mouth—but there are no studies that show that their long-term wear is safe, either. Some teeth grills are made from non-precious (base) metals that may cause irritation or metal allergic reactions.

Dental Grill

The trend toward tooth coverings was boosted in recent years by hip-hop icons and rappers such as Nelly and Paul Wall. Although wealthy musicians and some athletes have spent thousands of dollars to decorate their teeth with grills made of gold and platinum, most teenagers and young adults who want to emulate these celebrities do so by purchasing inexpensive do-it-yourself kits online or purchasing them from local jewelers. Some jewelers and other “grill” vendors are unaware that, in some states, taking an impression of someone’s mouth is considered dentistry, which requires a license.

Wearers should be especially careful about brushing and flossing to prevent potential problems. Food and other debris may become trapped between the teeth and the mouth grill allowing bacteria to collect and produce acids. The acids can cause tooth decay and harm gum tissue. Bacteria may also contribute to bad breath. There also is the potential for grills to irritate surrounding oral tissues and to wear the enamel away on the opposing teeth.

Cavities Related To Dental Grills

To prevent problems, wearers should limit the amount of time spent wearing removable grillz.
If you already wear a grill, you should remove it before eating. It should be cleaned daily to remove plaque bacteria and food debris. Avoid using jewelry cleaners or any products that are dangerous to ingest.

If you are considering getting a dental grill, make sure you talk to your dentist first. Find out exactly what materials the grill is made of and avoid creating a breeding ground for bacteria. Grills might be trendy for the moment, but “pearly whites” will never go out of style

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Tobacco Use and Gum Disease

If you are a smoker who is concerned about the effects smoking can have on your health, congratulations! By accessing information about the negative effects of tobacco use, you are taking the first step toward quitting.

Tobacco Use and Gum Disease

Cigarette Smoking

Surprising as it may sound, many smokers need to be made more aware of the dangers of tobacco use. In fact, just 29 percent of smokers say they believe themselves to be at an above-average risk for heart attack compared with their nonsmoking peers, according to a study published by the Journal of the American Medical Association.Obviously, while information about the medical problems associated with smoking – such as lung disease, cancer, heart disease and low-birth-weight infants – is widely available, many smokers seem to have tuned out.

If you are a smoker who is concerned about the effects smoking can have on your health, congratulations! By accessing information about the negative effects of tobacco use, you are taking the first step toward quitting.

To increase awareness of the dangers of cigarette smoking, the American Cancer Society sponsors the Great American Smokeout every year in November. Americans are encouraged to quit smoking for a day or to encourage someone else to quite for a day. The idea is to help someone be smoke-free for a day in hopes of motivating that person to quit forever.

The American Academy of Periodontology wants you to understand yet another good reason to quit: Tobacco use is harmful to oral health.

Smoking Effects on Oral Health

Time to Quit

In conjunction with the Great American Smokeout, the American Academy of Periodontology hopes to help educate the public about one specific threat to smokers – periodontal disease. Recent studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease. In addition, following periodontal treatment or any type of oral surgery, the chemicals in tobacco can slow down the healing process and make the treatment results less predictable.

How does smoking increase your risk for periodontal disease? As a smoker, you are more likely than nonsmokers to have the following problems:

  • Calculus – plaque that hardens on your teeth and can only be removed during a professional cleaning
  • Deep pockets between your teeth and gums
  • Loss of the bone and tissue that support your teeth

If the calculus is not removed during a professional cleaning, and it remains below your gum line, the bacteria in the calculus can destroy your gum tissue and cause your gums to pull away from your teeth. When this happens, periodontal pockets form and fill with disease-causing bacteria.

If left untreated, periodontal disease will progress. The pockets between your teeth and gums can grow deeper, allowing in more bacteria that destroy tissue and supporting bone. As a result, the gums may shrink away from the teeth making them look longer. Without treatment, your teeth may become loose, painful and even fall out.

Save Your Smile

Research shows that smokers loose more teeth than nonsmokers do. In fact, according to data from the Centers for Disease Control and Prevention, only about 20 percent of people over age 65 who have never smoked are toothless, while a whopping 41.3 percent of daily smokers over age 65 are toothless.

In addition, research shows that current smokers don’t heal as well after periodontal treatment as former smokers or nonsmokers. But these effects are reversible if the smokers kick the habit before beginning treatment.

Not Just Cigarettes

Other tobacco products are also harmful to your periodontal health. Smokeless tobacco use also can cause gums to recede and increase the chance of losing the bone and fibers that hold your teeth in place.

And, a study of cigar and pipe smokers published in the Journal of the American Dental Association revealed that cigar smokers experience tooth loss and alveolar bone loss at rates equivalent to those of cigarette smokers. Pipe smokers experience tooth loss at a rate similar to cigarette smokers.

Oral Cancer

Other Oral Problems

Researches also have found that the following problems occur more often in people who use tobacco products:

  • Oral cancer
  • Bad breath
  • Stained teeth
  • Tooth loss
  • Bone loss
  • Loss of taste
  • Less success with periodontal treatment
  • Less success with dental implants
  • Gum recession
  • Mouth sores
  • Facial wrinkling

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Acne Medication May Cause Gum Discoloration

Minocycline, one of the commonly prescribed antibiotics in the treatment of acne and rheumatoid arthritis, can cause the teeth and bone to discolor.

Acne Medication May Cause Gum Discoloration

Minocycline Induced Bluish Gum Tissue

A case report published in this month’s Journal of Periodontology reported that minocycline, one of the commonly prescribed antibiotics in the treatment of acne and rheumatoid arthritis, can cause the teeth and bone to discolor, which may make gum tissue to appear blackish-blue in color. Patients who take this drug or healthcare professionals who prescribe it should be made aware of the possibility of oral discolorationMayo Clinic researchers were presented with a 29-year old white female patient referred to the periodontics department by her dermatologist for an evaluation of the dramatic blue appearance of the gum tissue and bone surrounding her teeth. A review of her medical history indicated that she had been taking 50 mg of minocycline four times a day for the past 17 months.

Minocycline

“We informed the patient that in addition to the bone discoloration, her permanent teeth could also become discolored with continued use of minocycline. And, unlike the periodontal bone, discoloration of teeth from minocycline does not always resolve after discontinuation of the therapy,” said Phillip J. Sheridan, D.D.S., Mayo Clinic, Periodontics, Department of Dental Specialties. “In this patient’s case, the dermatologist elected to change antibiotics to treat her acne.”

“This case definitely ‘drives home’ the importance of collaboration between medical and dental professionals,” said Gordon Douglass, D.D.S. and president of the American Academy of Periodontology. “Periodontists have known for awhile that medical drugs can affect a person’s oral health, and this is a reminder for patients to inform their dental professionals of all medications they are taking.”

Acne Hair Follicle

For example, over 400 medications produce dry mouth, which can be damaging to the gum tissue, including periodontal disease and tooth decay. Other drugs like calcium channel blockers, phenytoin (used for treating seizures) and cyclosporine (used following organ transplants) may also cause gingival overgrowth.

According to this case report, approximately three to six percent of long-term users of minocycline will develop dental staining. This discoloration does not harm the teeth, bone or gum tissue, but is the reason behind the blackish-blue appearance of the gums. The periodontal bone can become discolored from minocycline therapy and show through the gum tissue, causing it to appear discolored as well.

“Like acne, periodontal disease can take away a person’s confidence and smile,” said Douglass. “Also like acne, periodontal disease is a chronic bacterial infection. Whereas acne inflames the walls of the acne hair follicles causing the walls to inflame and break, periodontal disease destroys attachment fibers and supporting bone that hold the teeth into the mouth.”

If you enjoyed this article, there is a good chance you will like this: “Gum Disease In a Nutshell“ and “Dental Gum Grafting: Types and Techniques“.  Thanks for reading !!

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